ANAHEIM, CA (UroToday.com) - Dr. Yuri Reinberg discussed the utilization of Sacral Nerve Stimulation (SNS) for children with dysfunctional elimination syndrome (DES). The experience is with 20 patients between the ages of 4 to 14 years with DES refractory to maximum medical therapy. He found that the SNS is effective in the majority of patients. Urinary incontinence, urgency, frequency, nocturnal enuresis, and constipation was improved or resolved in 82%, 69%, 80%, 63%, and 56%, respectively. Urinary retention requiring intermittent catheterization persisted in 75% of the patients.

Dr. Israel Franco discussed the importance of serotonin and norepinephrine in children with voiding problems changing the focus from a "vesicocentric" to "neurocentric". Dr, Venkata R. Jayanthi discussed the non-augment management of the neuropathic bladder and how augmentation plays a role, but should be the last resort. Robert Steckler, MD showed us that the overwhelming majority of patients requiring bladder augmentation are children with myelodysplasia. He states that tremendous commitments are required from both the patient and family. He also states that augmentation is not necessarily the end of the surgical journey and the take home message is that we must keep the kidneys healthy. Stephen Koff, MD discussed the important role in overnight catheter drainage, and how it prevents bladder and upper tract deterioration. We at the Children's Hospital of Philadelphia utilize overnight catheter drainage in patients with bladder storage issues that might jeopardize their upper tracts. Mark Hogan, MD showed how a simple percuatneous placement of a cecostomy tube can help patients with severe neuropathic constipation issues.

Historical discussions of some evolutionary ideas that have changed in pediatric urology were presented. Dr. Rafael Gosalbez talked about gastrocystoplasty and its current limited role. Brent Snow, MD presented autoaugmentation delineating the pros and cons. It seems there may be better approaches. The famous MAGPI procedure was discussed by Ross Decter, MD. Poll of the audience showed a few still utilize the procedure or some variation. Carols Estrada, MD eloquently presented supravesiclal diversion for bladder outlet obstruction and showed that it may in special circumstances still play a role. It seems that all would like the bladder to cycle, therefore not the best of options.

Douglas Canning, MD (Children's Hospital of Philadelphia) moderated a debate between Primary versus Staged closure for exstrophy with Dr. Richard Grady from Seattle Childrens arguing for Primary closure and Dr. Ranjiv Mathews, MD from Johns Hopkins arguing for the staged approach. Bottom line is that we need more long term data on the primary closure, although it is very promising in regards to continence compared to the staged closure.

Stephen Zderic, MD (Children's Hospital of Philadelphia) moderated a debate between Dr. Thomas Kolon (Children's Hospital of Philadelphia) and Dr. Marty Koyle (Colorado) arguing for and against primary therapy of UDT with hormonal therapy, respectively. It sounds like hormonal therapy is helpful only in verifying presence of testicular tissue in bilateral impalpable testes. Stephen Zderic, MD (Children's Hospital of Philadelphia) moderated another session on time and money allocation for basic science research. Douglas Coplen, MD (St' Louis, MO) argued against while Bradley Kropp, MD (Oklahoma City, OK) argued in favor. Bottom line, basic scince is important and we need to keep the process alive. The question in the future will overwhelmingly be…BUT HOW? Howard M. Snyder, MD (Children's Hospital of Philadelphia) moderated Deflux vs open reimplant by Andrew Kirsch (Atlanta, GA) and Jack S. Elder, MD (Cleveland, OH), respectively. May be the real question is should we be fixing reflux in the first place? Once we truly figure that one out, then we should look more into how to fix it.

The day ended with a video forum on minimally invasive surgery with Steven Docimo, MD (Pittsburg) as the moderator. Christina Kim, MD (Connecticut) presented a meta-analysis of the current literature involving the transperitoneal and retroperitoneal approaches. I (Pasquale Casale, MD Children's Hospital of Philadelphia) discussed how I perform the transperitoneal approach. Alaa El-Ghoneimi, MD (Paris, France) showed his technique on the retroperitoneal approach. Waalid Farhat, MD (Toronto Sick Kids, Canada) delineated which should be applied and when. He showed that the retroperitoneal was associated with more intraoperative hemodynamic instability, but the overall outcomes are the same. He also states that the transperitoneal approach is excellent for redo surgery. Lars Cisek, MD (Houston, TX) showed his extreme retropertinoeal surgical approach for RPLND and nephrectomy. All the videos were well done. Dr Stuart Bauer ended the day with an update for ICCS terminology.

UroToday.com Full Conference Reports

Written by Pasquale Casale, MD, a Contributing Editor with UroToday.

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